Pediatric Radiology

, Volume 41, Issue 4, pp 488–494

Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

  • Mi-Jung Lee
  • Myung-Joon Kim
  • Choon-Sik Yoon
  • Yong Eun Chung
  • Seok Joo Han
  • Hong Koh
Original Article

Abstract

Background

Biliary atresia (BA) is a progressive, obliterative cholangiopathy that occurs in neonates with hepatic portoenterostomy the treatment of choice, but early surgery is important for optimum outcomes. MRI, including MR cholangiopancreatography (MRCP) may be a diagnostically useful alternative to US, but the heavily T2-weighted sequences used include not only bile duct signals, but also other heterogeneously high signal intensities from surrounding structures.

Objective

To evaluate the effects of gadolinium when used to decrease background signal intensity on T2-weighted MR cholangiopancreatography (MRCP) in infants and to evaluate the qualitative improvement of the depiction of the common bile duct (CBD) for evaluating neonatal cholestasis.

Materials and methods

Our Institutional Review Board approved this prospective study. MRCP was performed with gadopentetate dimeglumine injection using a 1.5-T scanner. Pre- and postcontrast MRCP images were compared. Forty-nine infants (male:female = 21:28; age 0–12 months, mean 2.3) were included. The final diagnoses were biliary atresia (BA) in 28 cases and non-BA in 21. Quantitative analysis was conducted using region-of-interest measurements of mean signal intensities of the liver, pancreatic head and gallbladder (if defined). Qualitative analysis was performed by four radiologists who subjectively scored image confidence in the presence of CBD on a 4-point scale (0 for definitely absent, 1 for probably absent, 2 for probably present, and 3 for definitely present).

Results

The signal-to-noise ratios were significantly decreased in the liver and pancreatic head after contrast medium enhancement (mean 5.7→4.0 in liver and mean 44.9→12.7 in the pancreatic head; P < 0.0001), and this finding was constant in both the BA and the non-BA group. The mean confidence score in the presence of CBD decreased in the BA group (0.9→0.5; P < 0.0001), but did not change significantly in the non-BA group (2.0→2.1; P = 0.459) after contrast medium enhancement. Both intra- and interobserver agreement was higher after contrast medium enhancement (P = 0.046).

Conclusion

Gadopentetate dimeglumine-enhanced MRCP increased the diagnostic confidence of absence of the CBD in cholestatic infants with increased intra- and interobserver agreement.

Keywords

Cholestasis Biliary atresia MRI MR cholangiopancreatography Gadolinium Infant 

References

  1. 1.
    Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713PubMedCrossRefGoogle Scholar
  2. 2.
    Makin E, Quaglia A, Kvist N et al (2009) Congenital biliary atresia: liver injury begins at birth. J Pediatr Surg 44:630–633PubMedCrossRefGoogle Scholar
  3. 3.
    Carceller A, Blanchard H, Alvarez F et al (2000) Past and future of biliary atresia. J Pediatr Surg 35:717–720PubMedCrossRefGoogle Scholar
  4. 4.
    Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851PubMedCrossRefGoogle Scholar
  5. 5.
    Farrant P, Meire HB, Mieli-Vergani G (2000) Ultrasound features of the gall bladder in infants presenting with conjugated hyperbilirubinaemia. Br J Radiol 73:1154–1158PubMedGoogle Scholar
  6. 6.
    Choi SO, Park WH, Lee HJ (1998) Ultrasonographic “triangular cord”: the most definitive finding for noninvasive diagnosis of extrahepatic biliary atresia. Eur J Pediatr Surg 8:12–16PubMedCrossRefGoogle Scholar
  7. 7.
    Kamisawa T, Tu Y, Egawa N et al (2007) MRCP of congenital pancreaticobiliary malformation. Abdom Imaging 32:129–133PubMedCrossRefGoogle Scholar
  8. 8.
    Krause D, Cercueil JP, Dranssart M et al (2002) MRI for evaluating congenital bile duct abnormalities. J Comput Assist Tomogr 26:541–552PubMedCrossRefGoogle Scholar
  9. 9.
    Takaya J, Nakano S, Imai Y et al (2007) Usefulness of magnetic resonance cholangiopancreatography in biliary structures in infants: a four-case report. Eur J Pediatr 166:211–214PubMedCrossRefGoogle Scholar
  10. 10.
    Kanematsu M, Matsuo M, Shiratori Y et al (2002) Thick-section half-Fourier rapid acquisition with relaxation enhancement MR cholangiopancreatography: effects of i.v. administration of gadolinium chelate. AJR 178:755–761PubMedGoogle Scholar
  11. 11.
    Kuperman VY, Alley MT (1999) Differentiation between the effects of T1 and T2* shortening in contrast-enhanced MRI of the breast. J Magn Reson Imaging 9:172–176PubMedCrossRefGoogle Scholar
  12. 12.
    Elster AD, Sobol WT, Hinson WH (1990) Pseudolayering of Gd-DTPA in the urinary bladder. Radiology 174:379–381PubMedGoogle Scholar
  13. 13.
    May DA, Pennington DJ (2000) Effect of gadolinium concentration on renal signal intensity: an in vitro study with a saline bag model. Radiology 216:232–236PubMedGoogle Scholar
  14. 14.
    Takahashi S, Kim T, Murakami T et al (2000) Influence of paramagnetic contrast on single-shot MRCP image quality. Abdom Imaging 25:511–513PubMedCrossRefGoogle Scholar
  15. 15.
    Kim SM, Chang HK, Song JW et al (2010) Agranular platelets as a cardinal feature of ARC syndrome. J Pediatr Hematol Oncol 32:253–258PubMedCrossRefGoogle Scholar
  16. 16.
    Kuhl CK, Gieseke J, von Falkenhausen M et al (2005) Sensitivity encoding for diffusion-weighted MR imaging at 3.0 T: intraindividual comparative study. Radiology 234:517–526PubMedCrossRefGoogle Scholar
  17. 17.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  18. 18.
    Carneiro RC, Fordham LA, Semelka RC (2002) MR imaging of the pediatric liver. Magn Reson Imaging Clin N Am 10:137–164PubMedCrossRefGoogle Scholar
  19. 19.
    Miyazaki T, Yamashita Y, Tsuchigame T et al (1996) MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences. AJR 166:1297–1303PubMedGoogle Scholar
  20. 20.
    Glockner JF (2007) Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging 25:681–695PubMedCrossRefGoogle Scholar
  21. 21.
    Carlos RC, Hussain HK, Song JH et al (2002) Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment. AJR 179:87–92PubMedGoogle Scholar
  22. 22.
    Miyazaki T, Yamashita Y, Tang Y et al (1998) Single-shot MR cholangiopancreatography of neonates, infants, and young children. AJR 170:33–37PubMedGoogle Scholar
  23. 23.
    Jaw TS, Kuo YT, Liu GC et al (1999) MR cholangiography in the evaluation of neonatal cholestasis. Radiology 212:249–256PubMedGoogle Scholar
  24. 24.
    Weinmann HJ, Brasch RC, Press WR et al (1984) Characteristics of gadolinium-DTPA complex: a potential NMR contrast agent. AJR 142:619–624PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mi-Jung Lee
    • 1
    • 5
  • Myung-Joon Kim
    • 1
    • 5
  • Choon-Sik Yoon
    • 2
  • Yong Eun Chung
    • 1
  • Seok Joo Han
    • 3
    • 5
  • Hong Koh
    • 4
    • 5
  1. 1.Department of Radiology and Research Institute of Radiological Science, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
  3. 3.Department of Pediatric Surgery, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  4. 4.Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  5. 5.Severance Pediatric Liver Disease Research GroupSeoulSouth Korea

Personalised recommendations